Impact of self-reported visual impairment on quality of life in the Ibadan study of ageing

Subjective Wellbeing, Work Performance and Lived Experience of Zanzibari Women Entrepreneurs with Uncorrected Functional Presbyopia: A Pre-Post Mixed-Methods Study

PURPOSE

Uncorrected presbyopia has been shown to reduce Zanzibari women's quality of life. In this mixed-methods study, we examined the subjective wellbeing and self-reported work performance among older women entrepreneurs with functional presbyopia before and shortly after correction, and how poor vision at close distance affected their daily lives.

METHODS

Women entrepreneurs underwent eye examination to identify those with uncorrected functional presbyopia. Their subjective wellbeing and work performance were both measured in Cantril's ladder. Ready-made glasses were then provided and 30 minutes to an hour later, their subjective wellbeing and work performance was remeasured. Twenty women entrepreneurs were interviewed to understand their lived experience with uncorrected presbyopia.

RESULTS

Two-hundred-seventeen women entrepreneurs were included in the survey (mean age 51.6 years, SD 8.64). Women entrepreneurs had a mean subjective wellbeing score of 3.32 (SD 1.10) pre-correction and 5.99 (SD 1.13) post-correction (p < .001), and a mean self-rated current work performance score of 4.62 (SD 1.36) before correction and 5.47 (SD 1.35) post-correction (p < .001). One-hundred-and-ninety (87.6%) and 121 women entrepreneurs (55.8%) rated their current subjective wellbeing and work performance scores < 5, respectively. Around 1/4 of women entrepreneurs reported having severe difficulties with near tasks.

CONCLUSION

Poor vision at a close distance caused by uncorrected functional presbyopia negatively affected economic, physical and psychosocial aspects of women entrepreneurs' lives. Subjective wellbeing and self-reported work productivity scores improved significantly shortly after presbyopia was corrected. More research with longer follow-up is needed to understand the full benefits of correcting presbyopia.

Public Awareness, Knowledge of Presbyopia and Compliance to Eye Examination in Jordan

Purpose

To assess public awareness and knowledge about presbyopia and their compliance to ocular examination in Jordan.

Patients and Methods

A cross-sectional survey was designed to interview people in different provinces of Jordan. Socio-demographic data such as age, gender and level of education and region was reported. The first part of the questionnaire assessed awareness of presbyopia in terms of the need for spectacles with age, age of onset, possible causes of presbyopia and methods of presbyopia management. The second part of the questionnaire evaluated compliance of the participants with ocular examination in terms of frequency and motive to do general eye check, intraocular pressure (IOP), fundus exam and visual acuity.

Results

A total of 802 participants (232 males, 570 females) with an average age of 28 (±11.6) completed the questionnaire. Most participants (84.2%) knew that glasses are needed for near vision as age increases, and 62.8% estimated the age at which spectacles are required (40 years or older). Over half understood that presbyopia is correctable and progressive. Age significantly influenced knowledge about the need for near vision spectacles, and whether presbyopia is preventable and progressive (both p < 0.05). Females were more knowledgeable about these aspects. The frequency of eye examinations, particularly fundus exams and IOP tests, was significantly influenced by age but not by education. Gender only significantly affected the frequency of vision checks (p = 0.01), with females being more likely to adhere to them.

Conclusion

This study demonstrated a good level of awareness and knowledge about presbyopia among Jordanians, especially those over 40 and females. Regular eye check-ups were more common among young participants and females. Addressing misconceptions about presbyopia's preventability and promoting regular eye exams are crucial for early diagnosis and management of presbyopia and other serious eye conditions.

Social functioning in adults with visual impairment from minority ethnic communities in the United Kingdom

Background

Visual impairment (V.I.) has been associated with a negative impact on social functioning, while social support can impact on well-being in those with V.I. Adults from minority ethnic communities (MEC) are projected to make up an increasing proportion of adults living with V.I. in the UK, but limited research has explored their social functioning. This article provides a preliminary insight into social functioning among MEC adults living with V.I. in the UK.

Methods

The article reports findings from a secondary analysis of V.I. Lives survey data. V.I. Lives was a UK telephone survey, which explored the life experiences of people with V.I. across a wide range of topics including social functioning. This secondary analysis explored social participation, support, isolation, and relationships among a matched control sample of 77 MEC and 77 adults aged 18 and over from White communities (WC). Participants were matched on age, gender, UK region and urban/rural setting. Subgroup analyses were also conducted for the two largest subgroups within the MEC group, Asian (n = 46) and Black participants (n = 22).

Results

Contact with like-minded people (U = 2174.50, p = 0.003, r = -0.24) and opportunities to take part in more social activities (U = 2253.50, p = 0.007, r = -0.22) was significantly more important to MEC than WC participants. Moreover, MEC participants were significantly less likely to feel supported by friends/family (U = 3522.50, p = 0.017, r = 0.19) and had fewer people they could ask for help (U = 3775.50, p = 0.001, r = 0.26), but there were no significant differences in the perceived impact of V.I. on their friendships/social life and marriage/relationship, their ability to take part in a range of activities, nor their marital status. Asian participants were significantly more likely than Black participants to feel cut off from the people and places around them (U = 655.50, p = 0.042, r = 0.25). Effect sizes were overall small. Although there were no further statistically significant differences between the two groups, Asian participants were also less likely to be able to take part in activities, and more likely to report a negative impact on their social life/friendships and on their marriage/relationship, as well as a smaller social network.

Conclusion

The findings suggest that V.I. may have had a greater impact on social functioning among Asian participants in this sample, including on experiences of social isolation and participation in social activities. Future research will need to confirm these findings and explore the possible reasons.

Access to eye care and support services among adults from minority ethnic communities living with visual impairment in the United Kingdom

Background

Despite an increased risk of certain eye conditions which can lead to visual impairment (V.I.), there is evidence of a greater delay to treatment-seeking among adults from minority ethnic communities (MEC). MEC adults may also be underrepresented on V.I. registers, within early intervention services, and among the beneficiaries of national V.I. charities. However, much of this evidence is outdated or anecdotal.

Methods

This secondary analysis of V.I. Lives survey data explored use of eye health and support services and mobility aids among a matched control sample of 77 MEC and 77 adults aged 18 and over from white communities (WC). Participants were matched on age, gender, UK region and urban/rural setting. Additional subgroup analysis was conducted for Asian (n = 46) and black participants (n = 22).

Results

There were no significant group differences in areas such as eye health service use, registration status, contact with charities, and level of practical support received. But MEC participants were significantly more likely than WC participants to have received direct payments from social services to cover their care needs, Χ2 (1, 154) = 8.27, p = 0.004, and to use apps on their mobile for mobility, Χ2 (1, 154) = 5.75, p = 0.017. In contrast, WC participants were significantly more likely to agree that they were getting the level of emotional support to get on with their life, U = 3,638, p = 0.010, to feel confident to ask their friends for support, U = 2,416, p = 0.040, and to have a guide dog for mobility, Χ2 (1, 154) = 3.62, p = 0.057, although the latter did not reach statistical significance. Within the MEC group, Asian participants were significantly more likely than black participants to use a long cane, Χ2 (1, 68) = 7.24, p = 0.007, but they were significantly less likely to agree that they had received the right level of support when they started to experience V.I., U = 236.5, p = 0.040.

Conclusion

The preliminary findings suggests that there is scope to increase support provided by V.I. charities and the V.I. register, although, contrary to existing evidence, there were no statistically significant differences in eye health service use, registration status and use of wider support services. Further research is required to confirm these findings and explore reasons for differences.

Decreased Visual Search Behavior in Elderly Drivers during the Early Phase of Reverse Parking, But an Increase during the Late Phase

The aim of this study was to assess the characteristics of visual search behavior in elderly drivers in reverse parking. Fourteen healthy elderly and fourteen expert drivers performed a perpendicular parking task. The parking process was divided into three consecutive phases (Forward, Reverse, and Straighten the wheel) and the visual search behavior was monitored using an eye tracker (Tobii Pro Glasses 2). In addition, driving-related tests and quality of life were evaluated in elderly drivers. As a result, elderly drivers had a shorter time of gaze at the vertex of the parking space both in direct vision and reflected in the driver-side mirror during the Forward and the Reverse phases. In contrast, they had increased gaze time in the passenger-side mirror in the Straighten the wheel phase. Multiple regression analysis revealed that quality of life could be predicted by the total gaze time in the Straighten the wheel phase (β = -0.45), driving attitude (β = 0.62), and driving performance (β = 0.58); the adjusted R2 value was 0.87. These observations could improve our understanding of the characteristics of visual search behavior in parking performance and how this behavior is related to quality of life in elderly drivers.

Factors associated with health-related quality of life among home-dwelling older adults aged 75 or older in Switzerland: a cross-sectional study

BACKGROUND

HRQoL is an indicator of individuals' perception of their overall health, including social and environmental aspects. As a multidimensional concept, HRQoL can be influenced by a multitude of factors. Studies of HRQoL and factors associated with it among home-dwelling older adults have often been limited to inpatient settings or to a sub-population with a chronic disease. Studying HRQoL and its correlating factors among this population, by providing an ecological lens on factors beyond the individual level, can provide a better understanding of the construct and the role of the environment on how they perceive their HRQoL. Thus, we aimed to assess the HRQoL and investigate the correlates of HRQOL among home-dwelling older adults, guided by the levels of the ecological model.

METHODS

This is a cross-sectional population survey conducted in 2019 in Canton Basel-Landschaft, in northwestern Switzerland, and includes a sample of 8786 home-dwelling older adults aged 75 and above. We assessed HRQoL by using the EQ-index and the EQ-VAS. The influence of independent variables at the macro, meso and micro level on HRQoL was tested using Tobit multiple linear regression modelling.

RESULTS

We found that having a better socio-economic status as denoted by higher income, having supplementary insurance and a higher level of education were all associated with a better HRQoL among home-dwelling older adults. Furthermore, being engaged in social activities was also related to an improved HRQoL. On the other hand, older age, female gender, presence of multimorbidity and polypharmacy as well as social isolation and loneliness were found to all have a negative impact on HRQoL.

CONCLUSIONS

Understanding factors related to HRQoL by using an ecological lens can help identify factors beyond the individual level that impact the HRQoL of home-dwelling older adults. Our study emphasises the importance of social determinants of health and potential disparities that exists, encouraging policymakers to focus on policies to reduce socio-economic disparities using a life-course approach, which consequently could also impact HRQoL in later stages of life.

Vision-related quality of life amongst patients with low vision and blindness in a resource-limited country

PURPOSE

To evaluate the significance of sociodemographic and clinical variables on the quality of life of low-vision patients in a tertiary hospital in Enugu, Nigeria, and also determine the causative ocular pathologies and their vision-related quality of life.

METHODS

A cross-sectional study of adults 18 years and above with low vision/blindness. They were consecutively enrolled and clinically evaluated. The WHO-NEI-VFQ-25 questionnaire for quality of life was administered. Descriptive statistics were used to summarize variables. Kruskal-Wallis test, analysis of variance, and post hoc tests were done where appropriate.

RESULTS

Of the 400 participants, 81% were above 40 years. Mean age was 57.27 ± 16.34 years. Males (52.0%) and females (48.0%). 225 (56.25%) had Moderately Severe Visual Impairment. Low vision/blindness negatively affected the different domains of quality of life significantly, except ocular pain and dependency. Glaucoma and Cataract were the major disease conditions that affected most of the domains significantly. These conditions when poorly managed, due to poor and limited health resources, progress to low vision/blindness. Of all the socio-demographic factors and clinical variables studied, only age and severity of low vision were significant predictors of quality of life.

CONCLUSION

There is the need for prompt and proper treatment of low-vision patients and advocacy for the establishment of adequate and functional rehabilitation services. Quality of life which measures the overall impact of a disease on an individual was low in people with low vision and blindness. Low-vision services, which include rehabilitation, will provide comprehensive eye-care services and thus improve their quality of life.

All eyes on the price: An assessment of the willingness-to-pay for eyeglasses in rural Burkina Faso

Vision impairment is the most common disability worldwide and it is untreated in large parts of the developing world. We assess the willingness-to-pay (WTP) for eyeglasses among adults in a resource-poor rural setting. We elicit the WTP using the Becker-DeGroot-Marschak (BDM) method. We combine this approach with a layaway scheme and a video intervention to probe to what extent liquidity constraints and information influence the WTP. Our results show that the average WTP is close to the cost of production for corrective glasses. Nevertheless, we find evidence for information constraints. Our video intervention raises the WTP for corrective glasses by 16 percent. We do not find evidence of screening effects, that is after 6 months, use is unrelated to the initial WTP.

Comparative Analysis of the Impact of Visual Impairment on Quality of Life of Patients Attending a Tertiary Hospital in South East, Nigeria

Background

Quality of life (QoL) is defined as an "individual's perception of their position in life in the context of the culture and value system in which they live and in relation to goals, expectations, standards, and concerns." Visual Impairment affects QoL because of the restrictions it imposes on everyday life activities.

Aims

This study aims to compare the QoL of visually impaired patients attending the Eye Clinic of Federal Medical Centre, Owerri with that of normally sighted persons. The findings will aid the formulation of policies guiding the management of visually impaired patients.

Patients and Methods

This was a hospital-based case-control study which recruited all consenting new patients with visual impairment, and age, and sex-matched controls who presented at the Eye Clinic, Federal Medical Centre, Imo State, Nigeria during the period of the study. Data was collected using a semi-structured closed-ended questionnaire, and the World Health Organization QoL-BREF and analyzed with the Statistical Package for Social Science version 22.

Results

Four hundred and two participants were recruited. Lower scores were recorded in all the quality of life (QoL) domains for the visually impaired compared with controls. The overall QoL and health status mean score for the visually impaired (61.10 ± 19.75) was significantly lower than that for the controls (70.90 ± 21.19) at P < 0.001. Severity of visual impairment at P < 0.001 significantly affected all the QoL domains for the visually impaired with the lowest score noted among the blind (58.21 ± 11.63) compared to controls (79.33 ± 11.74). Occupation and educational level significantly affected the QoL of the study group but not the controls.

Conclusion

Visual impairment significantly reduces the QOL of patients. Policies targeted at enhancing the QoL of the visually impaired through rehabilitation and societal integration is recommended.

Visual impairment and ten-year mortality: the Liwan Eye Study

OBJECTIVES

To explore associations between visual impairment (VI) and mortality in an adult population in urban China.

METHODS

The Liwan Eye Study was a population-based prevalence survey conducted in Guangzhou, Southern China. The baseline examination was carried out in 2003. All baseline participants were invited for the 10-year follow-up visit. VI was defined as the visual acuity of 20/40 or worse in the better-seeing eye with habitual correction if worn. Correctable VI was defined as the VI correctable to 20/40 or better by subjective refraction, and non-correctable VI was defined as the VI correctable to worse than 20/40. Mortality rates were compared using the log-rank test and Cox proportional hazards regression models.

RESULTS

Of the 1399 participants (mean age: 65.3 ± 9.93 years; 56.4% female) with available baseline visual acuity measurement, 320 participants (22.9%) had VI. After 10 years, 314 (22.4%) participants died. Visually impaired participants had a significantly increased 10-year mortality compared with those without VI (40.0% vs. 17.2%, P < 0.05). After adjusting for age, gender, income, educational attainment, BMI, history of diabetes and hypertension, both VI (HR, 1.55; 95% CI, 1.14-2.11) and non-correctable VI (HR, 2.72; 95% CI, 1.86-3.98) were significantly associated with poorer survival, while correctable VI (HR, 0.99; 95% CI, 0.66-1.49) was not an independent risk factor for 10-year mortality.

CONCLUSIONS

Our findings that VI, particularly non-correctable VI, predicting poorer survival may imply the underlying mechanism behind VI-mortality association and reinforce the importance of preventing and treating disabling ocular diseases to prevent premature mortality in the elderly.

Eye health and quality of life: an umbrella review protocol

INTRODUCTION

Vision impairment and eye disease are major global health concerns and have been associated with increased morbidity and mortality, and lower quality of life. Quality of life, whether generic, vision-specific or disease-specific, is an important measure of the impact of eye health on people's daily activities, well-being and visual function, and is increasingly used to evaluate the impact of ophthalmic interventions and new devices. While many studies and reviews have examined the relationship between vision or eye health and quality of life across different contexts, there has yet to be a synthesis of the impact of vision impairment, eye disease and ophthalmic interventions on quality of life globally and across the lifespan.

METHODS AND ANALYSIS

An umbrella review of systematic reviews will be conducted to address these two questions: (1) What is the association of vision impairment and eye disease with quality of life? (2) What is the impact of ophthalmic interventions on quality of life? A search of related literature will be performed on the 11 February 2020 in Medline Ovid, Embase.com, Cochrane Database of Systematic Reviews, Proquest Dissertations and Theses Global, and the grey literature, and repeated at the synthesis stage. Title/abstract and full-text screening, methodological quality assessment and data extraction will be conducted by reviewers working independently and in duplicate. Assessment of methodological quality and data extraction will be performed using Joanna Briggs Institute standard forms. Findings from the systematic reviews and their methodological quality will be summarised qualitatively in the text and using tables.

ETHICS AND DISSEMINATION

No ethical approval is required. Results of this umbrella review will be published in a peer-reviewed journal and summarised in the Lancet Global Health Commission on Global Eye Health.

TRIAL REGISTRATION NUMBER

This protocol was registered in the Open Science Framework Registries (https://osf.io/qhv9g/).

Influence of Distance and Near Visual Impairment on Self-Reported Near Visual Functioning in a Multinational Study

PURPOSE

To assess the influence of distance and near visual impairment on self-reported near visual functioning (VF) in a multinational study.

DESIGN

Population-based cross-sectional study.

PARTICIPANTS

Participants aged 35 years or older were selected randomly with cluster sampling at 7 sites: rural sites in Nepal (Kaski) and India (Madurai), a semirural site in China (Shunyi), semiurban sites in South Africa (Durban) and Niger (Dosso), and urban sites in the United States (Los Angeles) and China (Guangzhou).

METHODS

Binocular presenting distance and near visual acuity (VA) were measured with a logarithm of the minimum angle of resolution tumbling E chart at 4 m and 40 cm, respectively. A 12-item near VF questionnaire interview was administered by trained local interviewers, with responses scored from 100 to 0 as visual disability increased. Multiple linear regression was used to investigate the association of age, gender, education, and VA with overall eyesight, difficulty with activities, and social functioning subscale scores.

MAIN OUTCOME MEASURES

Visual functioning subscale scores.

RESULTS

The study sample consisted of 6851 questionnaire respondents. The VF subscale scores decreased significantly with worse distance and near VA, and even mildly impaired VA could result in reduced VF. Lower VF subscale scores were associated with older age at 4 sites, female gender at 3 sites, and greater education at 2 sites. The influence of near VA was greater than distance VA at 3 sites, and at 1 site, distance VA was more influential than near VA. With study site included in the regression modeling, lower scores for the overall eyesight subscale (compared with the Shunyi reference site) were found in Guangzhou, Kaski, and Durban; lower difficulty in activities scores were found in Kaski and Durban, but better scores were found in Guangzhou and Madurai; and social functioning scores were lower in Kaski, Durban, and Dosso.

CONCLUSIONS

Along the entire VA spectrum, lower levels of distance and near VA led to significant reductions in VF subscale scores, with wide variation both within and between study sites. The impact of near vision on VF should receive greater emphasis with further investigation in various socioeconomic and cultural settings.

Visual impairment and social isolation, depression and life satisfaction among older adults in Ghana: analysis of the WHO's Study on global AGEing and adult health (SAGE) Wave 2

AIM

To estimate the prevalence of visual impairment (VI) and associated factors and further quantify its association with social isolation, depression and life satisfaction among older adults in Ghana.

METHODS

WHO Study on Global AGEing and Adult Health Ghana dataset for older adults 50 years and above was used for this study. Social isolation, depression and life satisfaction were our primary outcomes with VI being our secondary outcome. We employed negative binomial, Poisson and generalised negative binomial regression models individually modified with Coarsened Exact Matching method of analysis. All analysis was performed by adopting robust SE estimation using Stata V.15.

RESULTS

The prevalence of VI was 17.1% (95% CI14.3 to 20.2) and the factors associated include age groups, educational level, religion, region, where the participant was born, and difficulty in work/households activity (p<0.05). The inferential analysis shows that the significant log-likelihood score of social isolation and life satisfaction for older adults with VI was 0.25 more (95% CI 0.03 to 0.47) and 0.04 less (95% CI -0.08 to -0.01), respectively, compared with those without VI. The prevalence of depression among older adults with VI was significantly 90% higher compared with non-VI (adjusted prevalence ratio (95% CI) = 1.90 (1.17 to 3.09), p<0.001).

CONCLUSION

The prevalence of VI is associated with increasing age, educational level and self-rated health. VI was identified to be associated with social isolation, depression and diminishing life satisfaction. In order to achieve sustainable development goal #3, a national focus on geriatric care as part of the implementation of the National Ageing Policy will garner improvement in the quality of life of older adults with visual VI in Ghana. Eye health practitioners at all levels of the health systems should consider the psychosocial consequences of VI for the optimum care of the older adult client.

Burden of eye conditions at a specialised eye hospital in KwaZulu-Natal, South Africa

Background: Comprehension of the burden of eye diseases in an area is essential for adequate budgeting and resource allocation.Aim: The aim of the study was to describe the epidemiology of the presenting eye conditions at a provincial eye hospital.Setting: A retrospective audit was conducted of first-time presenting patients at the McCord Provincial Eye Hospital over a 6-month period.Methods: This was an observational, analytic cross-sectional study. Patients’ basic demographic and diagnoses were captured. Categorical variables were summarised using frequencies and percentages. Age was summarised using the mean and standard deviation. Differences in the number of patients seen per month, week and day of the week were compared using analysis of variance.Results: A total of 2250 new patients were seen over the 6-month period. There were more females (n = 1253, 55.7%) than males (n = 997, 44.3%). There were 186 (8.3%) patients (≤ 14 years). The three most common presenting conditions among adults were cataract (n = 743, 36.0%), posterior segment disorders (n = 397, 19.2%) and glaucoma (n = 261, 12.6%). Regarding posterior segment disorders, diabetic retinopathy was the commonest condition (n = 284, 71%), followed by retinal detachment (n = 34, 8.5%). Among the paediatric patients, the most common condition was squint (n = 55, 29.6%), followed by orbital conditions (n = 29, 15.6%) and cataract (n = 25, 13.4%).Conclusion: Audits of the burden of eye conditions provide useful information for human resource management; appropriate allocation, as well as availability of ophthalmologic equipment and staff, can be guided by making use of such information. Further studies and surveillance of eye conditions are needed to plan for better eye health services for patient care.

Vision-Related Quality of Life among Adult Patients with Visual Impairment at University of Gondar, Northwest Ethiopia

Purpose

The purpose of this study was to assess vision-related quality of life and associated factors among adult patients with visual impairment at the University of Gondar Tertiary Eye Care and Training Center, Northwest Ethiopia.

Methods

The institution-based cross-sectional study was conducted from April 24 to May 12, 2017, at the University of Gondar Tertiary Eye Care and Training Center among 484 patients with visual impairment. Pretested, structured National Eye Institute Visual Function Questionnaire-25 was used to collect data by interviewing. Data were entered using EPI-INFO version 3.5.1 and analyzed with SPSS version 20. Binary logistic regression was used to determine factors associated with vision-related quality of life. Variables with p value <0.05 in multivariable logistic regression were considered as statistically significant.

Result

A total of 484 study subjects participated with a response rate of 98.9%. The median age of the participants was 60 years with the interquartile range of 25 years. The proportion of poor vision-related quality of life was 238 (49.2%) (95% CI: 44.2%–53.3%). Age >75 years (AOR = 1.87 (95% CI: 1.02–3.40)), rural residency (AOR = 1.71 (95% CI: 1.13–2.60)), severe visual impairment/blindness (AOR = 2.76 (95% CI: 1.80–4.23)), and history of visual impairment longer than 3 years (AOR = 2.85 (95% CI: 1.61–5.04)) had statistically significant association with poor vision-related quality of life.

Conclusion

Almost half of the patients with visual impairment had poor vision-related quality of life. Severe visual impairment/blindness, long duration of visual impairment, older age, and rural residency had a statistically significant association with poor vision-related quality of life.

Impact of Visual Impairment and Blindness on Quality of Life of Patients in Owerri, Imo State, Nigeria

PURPOSE

This study sought to determine the quality of life (QOL) of patients with visual impairment in Federal Medical Centre, Owerri, Imo State, with a view to making recommendations for comprehensive management of patients.

MATERIALS AND METHODS

This was a hospital-based, cross-sectional study carried out at the Eye Clinic of Federal Medical Centre, Owerri, Imo State, Southeast Nigeria. New patients aged 18 years and older were consecutively recruited. Data were obtained using a semi-structured questionnaire and a World Health Organization's QOL Scale-Short Form (WHO-QOL-BREF). Participants had comprehensive eye examinations, and data were analyzed using the Statistical Package for the Social Sciences version 22.

RESULTS

One hundred and eight (53.7%) females and 93 (46.3%) males with a mean age of 55.92 ± 16.94 years participated in the study. The major causes of visual impairment were uncorrected refractive error, glaucoma, and cataract. Glaucoma (6.5%) was the leading cause of blindness. The overall QOL score was 61.10 ± 19.75, with the lowest mean score in the environmental domain. With increasing visual impairment, there was a 19.1% reduction in QOL. QOL was also affected by age, duration of visual impairment, and history of poor near vision.

CONCLUSION

The leading causes of visual impairment and blindness in this study are avoidable and treatable. Health education, appropriate intervention, and support groups should be encouraged. This may serve to reduce the burden of visual impairment and improve the QOL of patients.

Influence of presbyopia on smartphone usage among Chinese adults: A population study

IMPORTANCE

Presbyopia, an essentially universal, age-related loss of the ability to focus un-aided on near objects, is the world's leading cause of visual impairment.

BACKGROUND

Smartphone use is widespread in China, but little is known about the prevalence, determinants and correction of difficulties with smartphone use in the setting of presbyopia.

DESIGN

Cross-sectional data from a population-based longitudinal cohort study.

PARTICIPANTS

A total of 1817 persons aged ≥35 years in Guangzhou, Southern China.

METHODS

Participants underwent near visual acuity (NVA) testing and completed questionnaires on smartphone usage detailing knowledge of their own presbyopia status, frequency (hours/day) and subjective difficulties with use of mobile and smartphones. Presbyopia was defined as uncorrected bilateral NVA ≤6/12 with best-corrected bilateral NVA >6/12.

MAIN OUTCOME MEASURES

Difficulty in smartphone use associated with uncorrected presbyopia.

RESULTS

Among 1427 respondents (78.5%) undergoing examination, 1191 (83.5%) completed questionnaires (mean age 52.3 ± 11.6 years; 54.9% women). Among 451 persons (37.8%) with presbyopia owning smartphones, 290 (64.3%) reported difficulty using them. Multiple ordinal logistic regression modelling showed difficulty in smartphone use due to presbyopia was associated with higher educational level (P = .013), worse NVA (P < .001) and more time spent using smartphones (P = .002 for 1-3 hours/day). Among persons with presbyopia owning smartphones, 353 (78.0%) said they would pay >US$15 (median US$45) for innovations making smartphone use easier.

CONCLUSIONS AND RELEVANCE

Difficulty in using smartphones in the presence of presbyopia is common and affected persons are willing to pay for useful solutions to the problem.

Assessing the quality of life among Pakistani general population and their associated factors by using the World Health Organization's quality of life instrument (WHOQOL-BREF): a population based cross-sectional study

BACKGROUND

Measuring quality of life (QOL) in a population is important for the predictions of health and social care needs. In Pakistan, health related quality of life data exist but there are no quality of life data of general population. In this study, quality of life was assessed among the Pakistani general population and their associated factors by using the World Health Organization's quality of life instrument (WHOQOL-BREF).

METHODOLOGY

A population-based cross-sectional study was carried out in all 52 Union Councils of District Abbottabad, Khaber Pkutunkhua province, Pakistan from March 2015 to August 2015. Multi-stage cluster sampling technique was employed in this study. Quality of life was measured by using the validated WHOQOL-BREF instrument, along with socioeconomic, demographic, and World Bank social capital questions in this population- based study. The data were collected through households, utilizing face to face interviews. The association between socio-demographic variables and quality of life domains were determined by using both univariate and multivariate analysis. Descriptive statistics were derived, and a multilevel linear regression using backward analysis allowing to obtain final model for each domain was achieved to recognize the variables that affect quality of life score.

RESULTS

A total of 2063 participants were included in this study (51.2% male, 48.2% female). Mean age of participants was 37.9, SD = 13.2; ranging from 18 to 90. Mean score of quality of life domains (physical, psychological, social relationship and environmental domains) were 65.0 (SD = 15.2), 67.4 (SD = 15.0), 72.0 (SD = 16.5), 55.5 (SD = 15.0), respectively. Overall, socioeconomic status was established to be the strongest predictor of poorer quality of life for all domains as a change in SES from high to low results in reduction about (β = - 5.85, β = - 9.03, β = - 8.33, β = - 9.98, p < 0.001). Similarly, type of residency was negatively associated with physical, psychological and environmental domains while age and sex were negatively associated with physical, psychological and relationship domains in final model. Furthermore social capital (β = 0.09, β = 0.13, β =0.14, β =0.15, p < 0.001) had a positive effect on Pakistani quality of life. Overall, subjective quality of life was found to be low in our population and extremely varied by socio-demographic variables.

CONCLUSIONS

Increasing age, having average and lower socioeconomic status and living in the rural area were found to be the strong predictor of poorer quality of life in all domains, while total social capital score had a positive effect on Pakistani quality of life scores.

The Impact of Visual Disability on the Quality of Life of Older Persons in Rural Northeast Thailand

This study assessed the impact of self-reported visual disability on the quality of life of older persons in rural northeast Thailand. It found that those with a visual disability were worse off on 3 of 11 quality-of-life measures than were those who were sighted.

Determinants of the Overall Quality of Life of Older Persons who have Difficulty Seeing: The Importance of the Ability to Get Around

A model of vision rehabilitation that assumes that functional ability will affect the emotional and psychosocial adjustment of older persons with visual impairments, and ultimately their quality of life, was assessed using structured equation modeling. The proposed model was upheld. In addition, the ability to get around was found to contribute to both functional ability and quality of life.

Impact of Presbyopia and Its Correction in Low- and Middle-Income Countries

Presbyopia affects more than 1 billion people worldwide, and the number is growing rapidly due to the aging global population. Uncorrected presbyopia is the world's leading cause of vision impairment, and as with other causes. The burden falls unfairly on low- and middle-income countries (LMICs), in which rates of presbyopic correction are as low as 10%. The importance of presbyopia as a cause of vision impairment is further underscored by the fact that it strikes at the heart of the productive working years, although it can be safely and effectively treated with a pair of inexpensive glasses. To galvanize action for programs to address uncorrected presbyopia in the workplace and beyond LMICs, it is crucial to build a solid evidence base detailing the impact of presbyopia and its correction in important areas such as work productivity, activities of daily living, visual function, and quality of life. The aim of this review was to provide an up-to-date reference for program planners and policymakers seeking to build support for programs of presbyopia correction, particularly in low-resource settings.

Quality of life in older adults with sensory impairments: a systematic review

PURPOSE

Sensory impairments are common in older adults. Hearing and visual impairments affect their physical and mental health and quality of life adversely. However, systematic reviews of the relationship between hearing impairment, visual impairment, dual sensory impairment, and quality of life are scarce. The purpose of this systematic review was to determine the relationship between hearing impairment, visual impairment, dual sensory impairment, and quality of life.

METHODS

Searches of EMBASE, PubMed, CINAHL, MEDLINE, Cochrane Library, and Airiti Library were conducted between January 2006 and December 2017 using the keywords "quality of life," "life satisfaction," "well-being," "hearing impairment," and "visual impairment." Two authors independently assessed methodologic quality using a modified Downs and Black tool. Data were extracted by the first author and then cross-checked by the second author.

RESULTS

Twenty-three studies consisting mostly of community-dwelling older adults were included in our review. Sensory impairment was found to be in significant association with quality of life, with an increase in hearing impairment or visual impairment severity resulting in a lower quality of life. Quality of life for dual sensory impairment was worse than for hearing impairment or visual impairment individually.

CONCLUSIONS

A significant association was confirmed between hearing impairment, visual impairment, dual sensory impairment, and quality of life. Our review can be used to enhance health care personnel's understanding of sensory impairment in older adults and enable health care personnel to actively assess older adults' sensory functions, so that they can help alleviate the negative impact of sensory impairments on QOL in older adults.

The U-shaped association between self-reported sleep duration and visual impairment in Korean adults: a population-based study

OBJECTIVE

This study aimed to investigate the association between self-reported sleep duration and visual impairment (VI) in Korean adults.

METHODS

This population-based, cross-sectional study examined ophthalmologic data of 16,374 Koreans aged 19 years and older from the 2010-2012 Korea National Health and Nutrition Examination Survey (KNHNES V). VI data (best-corrected distance visual acuity worse than 0.5 logMAR in the better-seeing eye) were obtained from direct ophthalmologic examinations, and data on self-reported sleep duration (≤5, 6, 7, 8, or ≥9 h/night) were obtained using questionnaires. Multiple logistic regression analysis was conducted to examine the association between self-reported sleep duration and VI, and we also adjusted for possible covariates.

RESULTS

The weighted VI prevalences (95% CIs) were 1.23% (0.70-1.76), 0.40% (0.10-0.70), 0.18% (0.04-0.31), 0.42% (0.26-0.58), and 0.66% (0.25-1.07) for participants who slept ≤5, 6, 7, 8, and ≥9 h/night, respectively. Even after adjusting for demographic factors (age and sex), lifestyle factors (household income, occupation, smoking status, regular exercise, and suicidal thoughts), and medical factors (diabetes, hypertension, stroke, and history of ocular surgery), greater risk of VI was found in the ≤5 h/night (OR = 3.23, 95% CI: 1.43-7.31) and ≥9 h/night (OR = 2.56, 95% CI: 1.03-6.41) groups, compared to the 7 h/night group.

CONCLUSIONS

In Korean adults, self-reported sleep duration and VI exhibited a U-shaped association. Both very short (≤5 h/night) and very long (≥9 h/night) sleep durations were significantly associated with increased VI.

A situational analysis of ocular health promotion in the South African primary health-care system

BACKGROUND

South Africa has a serious burden of avoidable blindness and visual impairment, which may be due to poor ocular health promotional policies and programs or implementation. Therefore, this paper sought to critically analyse the South African primary health-care policies and programs, to identify the components of ocular health promotional policies and programs as well as how they are currently being implemented and to suggest areas that can be improved in order to minimise the burden of blindness and visual impairment.

METHODS

Triangulated quantitative and qualitative research methods were used in the study. Questionnaire and interviews were used to solicit data from national and provincial managers of different health directorates. Eye-care managers from each province also completed the questionnaire. Furthermore, relevant health policy and program documents from national and provincial departments of health were studied to identify areas relating to ocular health promotion.

RESULTS

The study found varying degrees of implementation of various ocular health promotional activities in the provinces with the majority of respondents (62 per cent) indicating that ocular health promotion was not part of their responsibility and another 81 per cent revealing that vision screening does not form part of their health promotional programs. It further revealed a lack of a dedicated directorate for ocular health-care issues and the absence of an integrated ocular health promotional policy.

CONCLUSION

Ocular health promotional activities were absent in other provinces. This may be a major contributing factor to poor ocular health promotion in South Africa and hence, the high prevalence of blindness and visual impairment. Therefore, it is recommended that an integrated ocular health promotional model (directorate and policies) be developed and be part of the South African primary health-care system.

Yoga-teaching protocol adapted for children with visual impairment

CONTEXT

Childhood visual deficiency impairs children's neuro-psychomotor development, considerably affecting physical, mental, social, and emotional health. Yoga's multifaceted approach may help children with visual impairment (VI) to cope with their challenges.

AIM

This study aimed to develop a special protocol for teaching yoga to children with VI, and to evaluate their preferred method of learning.

METHODS

The study was carried out at Ramana Maharishi Academy for the Blind, Bengaluru, South India. Forty-one students volunteered to learn yoga practices, and classes were held weekly 5 days, 1 hr per session for 16 weeks. The study introduced a new method using a sequence of five teaching steps: verbal instructions, tactile modeling, step-by-step teaching, learning in a group, and physical guidance. A questionnaire concerning the preferred steps of learning was then given to each student, and verbal answers were obtained.

RESULTS

A total of 33 (out of 41), aged 11.97 ± 1.94, 15 girls and 18 boys responded. Twenty-six (78.79%) chose physical guidance as their most favored learning mode.

CONCLUSIONS

Specially designed protocol may pave the way to impart yoga in an exciting and comfortable way to children with VI. More studies are needed to further investigate the effectiveness of this new yoga protocol in similar settings.

Visual function and vision-related quality of life in presbyopic adult population of Northwestern Nigeria

Purpose:

To determine the impact of uncorrected presbyopia on vision-related quality of life (QoL) and visual function (VF) among adults 40 years and older in Bungudu local government area (LGA) of Zamfara State, Nigeria.

Materials and Methods:

A population-based cross-sectional study in Bungudu LGA of Zamfara State Nigeria was conducted in 2012. Six-hundred and fifty persons at least 40 years of age were examined using a two-stage cluster random sampling-based on probability proportional to size. Presbyopia was defined as the inability to read N8 at 40 cm in an indoor illumination using LogMAR E-chart. Demographic information comprising of age, sex, occupation, and educational level among others was obtained from a pilot tested VF-14 and modified vision-related QoL questionnaire by trained interviewer.

Results:

Out Of the 650 subjects enumerated 635 were examined given a response rate of 97.7%. The mean age of participants was 53.59 years (95% confidence interval:52.75%-54.43%). The crude prevalence of presbyopia was 30.4%, (95% CI: 26.8%-34.1%). The mean VF score of persons with presbyopia was 85.09, (95% CI: 83.09%-87.09%) and being female was strongly associated with high VF scores (P = 0.003). The VFs most impaired were the ability to read, write, use mobile phones, and thread needles. The higher the degree of presbyopia the lower the mean VF score (P = 0.00).

Conclusion:

Uncorrected presbyopia is associated with functional visual impairment and reduce QoL especially in the ability to read, write, and usage of mobile cell phones among adults 40 years and older in Bungudu District.

The Relationship between Loneliness and Perceived Quality of Life among Older Persons with Visual Impairments

Introduction

This article explores the rate and degree of loneliness in community-dwelling older visually impaired people, and is the first study to investigate the unique contribution that social and emotional loneliness makes to perceived quality of life (PQOL) in this population.

Methods

The study constituted a secondary analysis of postal survey data from the second wave (2012) of the nationally representative New Zealand Longitudinal Study of Ageing, a longitudinal study of older New Zealanders. A total of 2,683 participants completed both the visual status screening question and all 11 loneliness items to meet the criteria for inclusion in this study.

Results

Those designated as being visually impaired ( n = 315) were found to be more likely to experience loneliness (53% vs. 36%) than their sighted peers ( n = 2,368). Increased loneliness among those who are visually impaired was found to be associated with decreased economic well-being, mental health, satisfaction with activities of daily living, satisfaction with life, and PQOL. Social loneliness, but not emotional loneliness, was found to make a unique contribution to the prediction of variance in the PQOL of older visually impaired people over and above the impact of other predictors.

Discussion

Loneliness is much more prevalent in, and occurs with greater severity among, people who are visually impaired than with those who are not. Social loneliness made a unique contribution to PQOL over and above the contribution of variables that previous research has shown are central to PQOL in this population.

Implications for practitioners

Loneliness is not often addressed in vision rehabilitation programs designed for older adults, yet it is apparent from these findings that rates of loneliness may be high in this population. Its effect, even at moderate levels, is detrimental to the PQOL of older people with visual impairments.

Quality of life (QOL) of the community-dwelling elderly and associated factors: a population-based study in urban areas of China

OBJECTIVE

China has the most elderly people. Maintaining and improving the QOL of the elderly has emerged as a particularly important issue. This population-based study aimed to examine the QOL of the urban elderly and to clarify the associated factors.

METHODS

A cross-sectional study was performed in Liaoning Province. The elderly people without senile dementia composed our study population and were interviewed from March to November, 2012 with questionnaires pertaining to QOL (SF-36), cognitive ability, demographic characteristics, health status, behavioral factors, and social-psychological factors. 4067 effective responses were received (effective response rate: 86.0%). After further cognitive screening, 3714 participants were included as the subjects.

RESULTS

The mean scores of physical component summary (PCS) and mental component summary (MCS) were 53.7±21.5 (mean±SD) and 58.9±18.9, respectively. With adjustment for age and sex, general linear model analysis showed that, in standardized estimate (β) sequence, PCS was significantly associated with chronic disease, taking a walk, visual ability, sleeping quality, marital status, alcohol consumption, hearing ability, smoking, neighborhood relationships, filial piety, ethnicity, and regular diet, and MCS was associated with chronic disease, sleeping quality, taking a walk, visual ability, marital status, ethnicity, filial piety, regular diet, alcohol consumption, smoking, and hearing ability.

CONCLUSIONS

The community-dwelling elderly in urban areas had a low level of QOL. To improve QOL, the maintenance of health conditions was crucial. Efforts to encourage the elderly to perform feasible exercise and develop good lifestyles should be focused on. Also, children's filial duty to their parents should be enhanced.

Health-related quality of life among people aged ≥65 years with self-reported visual impairment: findings from the 2006-2010 behavioral risk factor surveillance system

PURPOSE

To examine the association between health-related quality of life (HRQoL) and visual impairment among people aged ≥65 years.

METHODS

We used cross-sectional data from the 2006-2010 Behavioral Risk Factor Surveillance System to examine six HRQoL measures: self-reported health, physically unhealthy days, mentally unhealthy days, activity limitation days, life satisfaction, and disability. Visual impairment was categorized as no, a little, and moderate/severe. We examined the association between self-reported visual impairment and HRQoL using logistic regression accounting for the survey's complex design.

RESULTS

People with self-reported moderate/severe visual impairment had more frequent (≥14) physically unhealthy days, mentally unhealthy days, and activity limitation days in the last 30 days compared to those reporting a little or no visual impairment. After controlling for all covariates (age, sex, marital status, race/ethnicity, education, income, diabetes, heart disease, stroke, heart attack, body mass index, leisure time activity, smoking, and medical care cost concerns) and comparing to those with no self-reported visual impairment, people reporting a little visual impairment were more likely to have fair/poor health (odds ratio, OR, 1.2, 95% confidence interval, CI, 1.1-1.3), life dissatisfaction (OR 1.6, 95% CI 1.3-2.0), and disability (OR 1.5, 95% CI 1.3-1.6), and those with self-reported moderate/severe visual impairment had more fair/poor health (OR 1.8, 95% CI 1.6-2.0), life dissatisfaction (OR 2.3, 95% CI 1.8-2.9), and disability (OR 2.0, 95% CI 1.8-2.2). They also had more frequent physically unhealthy days (OR 1.9, 95% CI 1.7-2.1), mentally unhealthy days (OR 1.8, 95% CI 1.5-2.1), and activity limitations days (OR 1.9, 95% CI 1.6-2.2).

CONCLUSION

Poor HRQoL is strongly associated with the severity of self-reported visual impairment among people aged ≥65 years.

Review of the impact of presbyopia on quality of life in the developing and developed world

PURPOSE

To examine the public health impact of presbyopia regarding its effect on quality of life (QoL) and society in both the developed and developing worlds.

METHODS

A database was created from articles found on PubMed, the Cochrane Library and Science Direct using the following search terms: presbyopia, QoL, accommodation, impact, cost, prevention, treatment and public health. Articles were accepted into the database if they addressed presbyopia and public health.

RESULTS

This study showed in the developed world presbyopic subjects treated with reading glasses suffered a reduction in QoL parameters compared with those who were younger and emmetropic. A small minority of subjects were assessed to be a candidate for additional non-spectacle treatment measures. In undeveloped areas, the manifestations of presbyopia were similar to the developed world in symptoms, age and reduced QoL. However, there was inadequate treatment of this condition, even with reading glasses. The availability of reading glasses ranged from 6 to 45%. Activities of daily living could not be accomplished as easily without near correction of reading. Reasons described for the lack of correction included: lack of access to medical care, poor awareness of decreased near vision, lack of motivation and cost. Overall scant data exist regarding presbyopia and its impact and how treatment affects QoL.

CONCLUSIONS

This review suggests that the effect of presbyopia and its treatments on QoL remain poorly described and incompletely treated, especially in developing areas of the world.

Quality of life in patients with visual impairment in Ibadan: a clinical study in primary care

BACKGROUND

Visual function is important for optimal orientation in functional and social life, and has an effect on physical and emotional well-being. Visual impairment, therefore, leads to restrictions in all aspects of daily living and is related to quality of life. The aim of this study was to provide information on the causes of visual impairment in patients presenting to their family physician, the spectrum of impairment, and its impact on quality of life for these patients.

METHODS

This descriptive cross-sectional study of 375 adult patients with ocular symptoms was performed in the general outpatient department of the University College Hospital, Ibadan, from July to September, 2009. After checking their presenting visual acuity, the patients were interviewed using the Vision-Related Quality of Life questionnaire to determine the impact of visual impairment on their quality of life. Ophthalmic examinations were performed to determine the causes of visual impairment. The results were analyzed using proportions and percentages.

RESULTS

The main causes of visual impairment were cataracts (58.7%), refractive error (19.4%), and glaucoma (2.9%). Visual impairment was found to be associated with advancing age, low education, and unemployment (P<0.001). Most patients (85.1%) were found to have good quality of life overall. Quality of life was found to be poor in the domains of visual function (64.2%) and social interaction (50.9%). Quality of life was found to be related to the degree of visual impairment, ie, blind patients reported poor quality of life (41.4%) when compared with those having low vision (8.6%) or near normal vision (2.4%, P<0.001).

CONCLUSION

This study identified poor quality of life in patients with a higher degree of visual impairment. Family physicians need to identify these visually impaired patients early and make timely referrals.

Associations between self-rated vision score, vision tests, and self-reported visual function in the Salisbury Eye Evaluation Study

PURPOSE

We attempt to understand the determinants of self-rated vision status by examining associations with vision tests, self-reported visual function, demographic, and health-status characteristics.

METHODS

Participants included 2467 individuals, aged 65 to 84 years, in a longitudinal, population-based cohort study. Participants rated their vision status from 0 to 10. Visual acuity, contrast sensitivity, stereoacuity, and visual fields were assessed. The Activities of Daily Vision Scale (ADVS) questionnaire was administered. Multivariate ordinal and multinomial logistic-regression models examined the association of demographic, health-status characteristics, vision tests, and ADVS subscales with self-rated vision status score. Odds ratios described the association of these characteristics with reporting better vision status.

RESULTS

Better visual acuity, contrast sensitivity, stereoacuity, and visual fields were associated with increased odds of reporting better vision status. Among the vision tests, a 2-line increase in visual acuity was most likely to result in an individual reporting better vision status (odds ratio, 1.49; 95% confidence interval [CI], 1.30-1.70). A 5-point increase in the near vision and far vision ADVS subscale scores was associated with increased odds of reporting good versus poor vision status. A 5-point increase in the near vision subscale was most likely to result in an individual reporting good versus poor vision status (odds ratio, 1.38; 95% CI, 1.28-1.50).

CONCLUSIONS

Self-rated vision status is a multidimensional measure. Near-vision visual function, visual acuity, and contrast sensitivity are important determinants of self-rated vision status in an elderly population. This understanding may improve the ability of eye care providers to maximize self-rated vision status among their patients.

Quality of life and associated factors among adults in a community in South west Nigeria

BACKGROUND

Quality of life (QoL) is an important measure in the assessment of population well being and health status. However despite locally validated measuring tools, little is known about the quality of life and associated factors in Nigerian adults.

OBJECTIVE

This study therefore aimed to assess QoL and contributory factors among adults residing in a sub urban Nigerian community.

METHODS

A descriptive cross-sectional study of 527 adults, in Oru community was conducted. An interviewer-administered questionnaire adapted from the WHO quality of life (WHOQOL-BREF) questionnaire was used to obtain information from respondents. Associations were explored with the chi square test; multivariate analysis was done with logistic regression at 5% level of significance.

RESULTS

Respondents mean age was 33.3 ±8.1 years. In all, 46.5 % were currently married or cohabiting. Christianity was the dominant religion, 72.7%. In all, 81.6% had good QoL. Predictors of good QoL were respondents less than 25 years [OR: 3.5 (1.264-9.508)], having educational level that is secondary and above [OR: 4.2 (1.810-9.762)]. Being Unemployed [OR: 1.9 (1.099- 3.351)], living in flats and other bigger apartments [OR: 1.8 (1.121- 3.04)], currently ill [OR: 3.7 (2.096- 6.509)], and lack of involvement in religious activities [OR: 3.1 (1.166- 8.045)] were also shown to be predictors of good QoL.

CONCLUSION

The majority of those evaluated had good QoL. Further surveys involving larger samples sizes are required to explore the QoL in distinct sub-populations and in currently ill patients to strengthen the results of this study.

The impact of reduced distance and near vision on the quality of life of adults in Timor-Leste

PURPOSE

To determine the independent, relative, and combined impact of reduced distance and near vision on the vision-specific quality of life (VS QOL) of adults in Timor-Leste.

DESIGN

A population-based cross-sectional eye health survey was conducted in urban and rural areas in Timor-Leste.

PARTICIPANTS

Participants were 40 years or older. Those with better eye presenting distance vision worse than 6/18, and every third participant with 6/18 or better vision, completed the VS QOL questionnaire: in total 704 of the 1414 participants.

METHODS

Distance and near visual acuities were measured and eye health was assessed. The VS QOL questionnaire administered by interview was analyzed using Rasch analysis, univariate analysis, and linear regression to determine associations between VS QOL, demographic factors, and levels of visual impairment.

MAIN OUTCOME MEASURES

The Timor-Leste VS QOL questionnaire results.

RESULTS

Rasch analysis confirmed that for participants both with and without visual impairment, the Timor-Leste VS QOL questionnaire provided a valid and reliable measure, was unidimensional, and had appropriate response categories. There was a consistent pattern of deterioration in VS QOL as vision worsened: for each category of distance- and near-vision impairment, there was an independent and significant change in Timor-Leste VS QOL scores between no visual impairment and either mild, moderate, or severe impairment (P < 0.05). Combined distance- and near-vision impairment was associated with a greater impact on VS QOL than categories separately, the impact of severe distance- and near-vision impairment being the greatest and clinically significant: -3.05 (95% confidence interval [CI], -3.60 to -2.49; P<0.05; and 95% CI, <-1.0). Distance vision (37.2%) contributed relatively more than near vision (4.7%) to the total variance in VS QOL (41.9%). Older people, those not married, not literate, and rural dwellers had significantly worse Timor-Leste VS QOL scores (P < 0.05).

CONCLUSIONS

This study provides evidence of independent dose-response relationships between distance- and near-vision impairment and poorer VS QOL. Distance-vision impairment had a relatively larger impact on VS QOL than near-vision impairment. Combined distance- and near-vision impairment was associated with a greater impact on VS QOL compared with the independent impact of distance- or near-vision impairment at similar levels.